“Walking in a maze”: community providers’ difficulties coordinating health care for homeless patients

Zucchero, Terri LaCoursiere; McDannold, Sarah; McInnes, D. Keith

doi:10.1186/s12913-016-1722-x

Cited by 14 publications

(7 citation statements)

References 21 publications

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“…Therefore, a stronger, more cohesive link between VA and non‐VA care data also has the potential to improve patient outcomes by enhancing postdischarge planning and aftercare. Conversely, inadequate sharing of information could compromise efforts to identify and improve postdischarge outcome for homeless Veterans who have recently been hospitalized (LaCoursiere Zucchero, McDannold, and McInnes ).…”

Section: Discussionmentioning

confidence: 99%

“…). Dual use may be a particular concern for homeless Veterans given the complex health care needs, high use of acute care services, and the importance of integrating primary care, behavioral health care, and social services for this population (LaCoursiere Zucchero, McDannold, and McInnes ). Unfortunately, there is limited understanding of dual use of VA and non‐VA care for homeless Veterans.…”

mentioning

confidence: 99%

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Dual Use and Hospital Admissions among Veterans Enrolled in the VA's Homeless Patient Aligned Care Team

Trivedi

Jiang

Johnson

et al. 2018

Health Services Research

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Objective To examine the association between reliance on VA outpatient care and hospital admissions among Medicare‐eligible Veterans enrolled in the Homeless Patient Aligned Care Team (H‐PACT). Data Sources/Study Setting Registry of H‐PACT enrollees linked to VA and Medicare utilization data for 2013. Study Design After assigning Veterans to two groups according to whether they received >90 percent of outpatient care in VA (higher reliance) or <90 percent of outpatient care in VA (lower reliance), generalized linear models with inverse probability of treatment weights were used to estimate the association of reliance with Medicare and VA‐financed hospital admissions. Principal Findings Compared with higher reliance Veterans, lower reliance Veterans had an equivalent number of annual VA hospitalizations (0.63 vs. 0.50; p = .14) but substantially greater Medicare hospitalizations (0.85 vs. 0.08; p < .001). Among Veterans in the highest tertile of outpatient visits, we observed statistically similar rates of VA hospital use but over 10‐fold greater rates of Medicare‐financed hospitalizations (1.31 for lower reliance vs. 0.15 for high reliance; p < .001). Conclusions Among Veterans receiving integrated care in VA's H‐PACT, dual use of Medicare and VA outpatient care is strongly associated with acute hospitalizations financed by Medicare. Linking VA and non‐VA data may identify a subset of homeless Veterans with fragmented outpatient care who are at increased risk of poor outcomes.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Dual Use and Hospital Admissions among Veterans Enrolled in the VA's Homeless Patient Aligned Care Team

Trivedi

Jiang

Johnson

et al. 2018

Health Services Research

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“…Even though concerns have been raised that dual Medicaid-VA enrollment could lead to more fragmented care, 31 lower quality of care, duplicative care, and higher costs, 28 , 32 Medicaid coverage may offer critical access during disasters when VA medical facilities are closed or alternative VA medical facilities are limited. Natural disasters do not necessarily affect all healthcare facilities when they strike a community, and thus some non-VA facilities could be operational following a disaster even if all VA and some non-VA facilities close because of the event.…”

Section: Discussionmentioning

confidence: 99%

Access to Care for Homeless Veterans During Disasters

Gable

Der‐Martirosian

Dobalian

2018

J Prim Care Community Health

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Introduction: Since 1970, natural disasters have led to both temporary and permanent closures of multiple medical centers and outpatient clinics at the US Department of Veterans Affairs (VA) nationwide. Access to care during such events is critical for vulnerable populations, especially homeless veterans. As such, facility closures may disproportionately affect homeless veteran patients who are both more likely to experience adverse effects from disasters and face multiple barriers to care. Methods: A cross-sectional survey was administered to a probability sample of 2000 homeless VA patients living in and receiving VA health care in the Northeast United States. The survey was completed by 383 respondents (20% adjusted response rate). This pilot study examines predictors of difficulty accessing care in the event that the VA facility that homeless VA patients routinely use is forced to close because of a natural disaster. Results: In a multivariate logistic regression, homeless VA patients who had Medicaid were less likely (OR 0.38; 95% CI: 0.18-0.78; P < .01) to report that they would have difficulty obtaining care elsewhere if their normal VA facility was closed in a future natural disaster. Conclusions: Findings suggest that Medicaid coverage has the potential to facilitate access to care for homeless veteran VA patients during disasters. Policy changes that decrease Medicaid coverage could limit access to care for homeless veterans during closures of VA medical facilities.

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“…Prior research has largely focused on people actively experiencing homelessness as opposed to their health needs after being housed (Argintaru et al, 2013; Asgary et al, 2014; Davidson et al, 2014; Gabrielian et al, 2016; Henwood et al, 2013; McDonald, 2009; Ramsay et al, 2019; Wen et al, 2007). Additionally, there is a paucity of literature on how to understand the health outcomes that matter most to people with lived experience of homelessness, and how to incorporate these insights to design care that gets better results for this population (LaCoursiere Zucchero et al, 2016).…”

mentioning

confidence: 99%

Achieving Calm: A Study on the Health Care Experiences of People With Lived Experience of Homelessness in Central Texas

Christian

McFall²,

Suarez

et al. 2022

Qual Health Res

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The experiences of care of people with lived experience of homelessness are rarely embraced to change care delivery. We conducted qualitative group and one-on-one interviews utilizing experience group methodology with 27 people with lived experience of homelessness currently housed in one permanent housing community in central Texas. We analyzed data using an inductive thematic approach to identify shared obstacles and barriers to receiving health care. We then analyzed findings with the capability, comfort, and calm value framework to identify health outcomes that matter most to study participants. Poor access to care, discontinuities in care, distrust in providers, and confusing terminology were identified as the biggest barriers to health. The overwhelming majority of experiences reflected poor health outcomes of calm, the outcome of a health care experience that adds ease to one’s life rather than logistical and administrative chaos. We propose three practical approaches to achieve calm for this population as follows: systems-level embracement of compassionate care, integration of relationship-based care navigation into all levels of care, and building efficient transportation into care design. We conclude that designing health care that works in the lives of people with lived experience of homelessness is critical to address the gaps in care that fuel the health disparity these individuals face compared to people without this lived experience.

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“Walking in a maze”: community providers’ difficulties coordinating health care for homeless patients

Cited by 14 publications

References 21 publications

Dual Use and Hospital Admissions among Veterans Enrolled in the VA's Homeless Patient Aligned Care Team

Dual Use and Hospital Admissions among Veterans Enrolled in the VA's Homeless Patient Aligned Care Team

Access to Care for Homeless Veterans During Disasters

Achieving Calm: A Study on the Health Care Experiences of People With Lived Experience of Homelessness in Central Texas

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